NHS faces staffing ‘meltdown’ if pensions row is not solved, trusts warn

High-earning consultants ‘voting with their feet’ by declining shifts or retiring early

Patients are facing longer waiting times for treatment and hospitals are having to cancel operations as the fallout from an ongoing NHS pensions row deepens, according to hospital leaders.

NHS Providers, which represents English trusts, said the situation had become so dire that the government had “three or four weeks” to address the pensions dispute – which has seen doctors and other senior employees cut back on shifts or take early retirement for fear of facing large tax bills – before more serious issues arise. 

Chris Hopson, chief executive of NHS Providers, said the dispute was escalating so quickly it would send NHS into “meltdown” if the government did not take immediate action. He added that hospital leaders were warning they would be unable to meet waiting list targets unless drastic action was taken.

The issue arose after regulations introduced in 2016 limited the sums that could be paid into public sector pension pots by high earners without losing tax relief. These changes have led to rising numbers of consultants retiring early or not undertaking additional shifts rather than breach the £1.1 million lifetime allowance for pension saving, which would put them into a higher tax bracket, effectively making it financially detrimental to continue working. 

The issue is linked to an ongoing dispute involving firefighters’ pensions – but the greater number of high earners in the NHS has meant its implications are potentially more profound.

The issue has led to hospitals struggling to find enough doctors to fully staff shifts, and NHS Providers said the resulting gaps in rotas posed a threat to the quality and safety of care.

The Royal Bournemouth hospital in Dorset, part of Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, reported it may have to cancel operations in the coming weeks because none of its consultant anaesthetists were prepared to help staff 53 scheduled surgery sessions. 

The Guardian reported the situation arose because the hospital's anaesthetists feared that by working above their usual hours, they would end up financially worse off – a situation it said was being replicated in other parts of the country.

In June, health secretary Matt Hancock announced a review of the pension changes in the Interim NHS People Plan to give doctors more flexibility on their contributions. A ‘50:50’ option would allow NHS employees to put smaller amounts into their pension for up to 10 years to reduce the risk of breaching the £1.1 million lifetime allowance.

The British Medical Association (BMA) dismissed Hancock’s option for failing to go far enough. Dr Chaand Nagpaul CBE, the BMA’s chair of council, said the current policy was “driving doctors out of the workforce”, and the BMA had alerted the government to the reality of “losing large swatches of expertise” from the NHS. 

“This option will not only result in doctors receiving a lower pension, but it also does not remove the perverse incentive for doctors to reduce the work they do for the NHS,” Nagpaul said. “This is particularly the case if there is no recycling of employers’ pension contributions back to the employees.”

Hopson said it was clear that Hancock’s proposal was insufficient, and the profession could no longer wait for the conclusion of a government consultation process on NHS pension reform. 

“We were waiting to see if the proposal would work, and it clearly hasn’t,” Hopson said. “Staff are voting with their feet.” 

Last week, a dozen doctors announced they were taking legal action against the government because they believed the NHS pension scheme, which they say they were “forced” to join, would result in significant financial losses on retirement.

The action, backed by the BMA’s legal team, came in the wake of the government being refused leave to appeal a Court of Appeal decision in favour of the Fire Brigades Union (FBU) during a dispute over changes made to firefighters’ pensions in 2015. 

The changes meant older members could stay in the existing pension scheme, but younger members had to transfer to a new scheme, which they felt was financially detrimental to them. The FBU argued the changes imposed on younger members were unlawful on age, sex and race discrimination grounds. 

The BMA said that although doctors’ pension schemes were different, it believed the underlying legal principles were essentially the same and it wanted the government to agree the changes adversely affected younger members.